EP1195141A2

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Publication number: EP1195141A2
Application number: EP01308195A
Authority: EP
Inventors: Robert D. Fraser
Original assignee: DePuy Spine LLC; DePuy Acromed Inc
Current assignee: DePuy Spine LLC
Priority date: 2000-09-27
Filing date: 2001-09-26
Publication date: 2002-04-10
Also published as: AU6563201A; US6464634B1; JP2002153476A; KR20020025043A; EP1195141A3; CA2357716A1; AU755400B2

Abstract

A surgical retractor system comprises a support frame and at least one retractor blade. Thesupport frame has a generally horizontally oriented support member comprising a pluralityof holes. The surgical retractor has at least one retractor blade which is mateable at aselected position on the support frame. At least one retractor blade of the surgical retractorsystem has an open access window which provides greater visual and physical access to thesurgical field.

Description

The present invention relates to medical devices, in particular to a surgicalretractor blade and system.
Even with the advent of minimally invasive surgical techniques, many surgicalprocedures still require an exposed surgical field for the surgeon to successfully perform.Often, the greater the visibility and access a surgeon has to a surgical site, the greater theprobability that a successful outcome will result. Once entry is made into a patient, softtissue is dissected away further exposing the field. However, the exposed field must bemaintained using instruments that do not obstruct either visual or physical access.
Surgical retractors are used to maintain exposure and access to a surgical field.There are a variety of retractors, and different surgical protocols require different styles ofretractors. For example, in lumbar surgery the retractor needs to be strong enough toovercome the force exerted by the large muscle mass that has been dissected away from thefield of exposure, while maintaining a visual field and access by the surgeon. Additionally,retractors are required to partition other soft-tissue components of the surgical field. Thisneed has lead to retractor systems having solid blades connected to a firm blade-holdingretractor frame. US-5520608 discloses a curved, solid retractor blade useful for orthopaedicsurgery.
During surgery, it is advantageous to have retractor blades that are removablyattachable to a support frame. US-4421108 discloses an example of a quick-releaseratcheting holder for a surgical retractor. Other mechanisms for holding a retractor blade inposition are disclosed in US-4424724,US-4467791, US-5375481, US-5616117 andUS-5893831.
Accordingly, there exists a need for greater flexibility in a surgical retractorsystem while improving both visual and physical access by the surgeon to the surgicalfield.
The present invention provides a surgical retractor blade and system useful forsurgical procedures, including orthopaedic and spinal surgery. In one embodiment, thesurgical retractor blade of the invention is used with a support frame that includes ahorizontally oriented support member having a plurality of mounting holes. This surgicalretractor system further includes at least one retractor blade which is mateable at a selected position on the support frame. The retractor blade includes an open access window thatfacilitates both visual and physical access to the surgical wound.
The retractor blade of the present invention has a substantially elongated,horizontally oriented mounting portion with a longitudinally extending slot formed therein.The retractor blade also comprises a tissue-retracting portion which is integral with anddistal to the mounting portion. The tissue-retracting portion has a first section which iscoplanar with the mounting portion, and a second section which is angularly oriented withrespect to the first section. The open access window is substantially centrally formed, andit is present in both the first and second sections of the tissue-retracting portion of theretractor. The second section of the tissue-retracting position of the blade is preferablyangularly oriented with respect to the first section. The angle of orientation is in the rangeof about 45° to 135°.
The retractor blade also comprises a fastening mechanism that effectively enablesit to mate to the support frame in a desired position. In one embodiment, a mounting screwis used to mate the retractor blade to the support frame. Other fastening mechanisms, suchas clamping devices, can also be used to fasten the retractor blade to the support frame.
Embodiments of the present invention will now be described by way of examplewith reference to the accompanying drawings, in which:
Figure 1 is a perspective view of a surgical retractor system of the presentinvention in use during a surgical procedure;
Figure 2A is a perspective view of the surgical retractor system of Figure 1;
Figure 2B is an exploded, disassembled view of the system shown in Figure 2A;
Figure 3A is a perspective view of a surgical retractor system according to anotherembodiment of the invention;
Figure 3B is an exploded, disassembled view of the system shown in Figure 3A;
Figure 4 is a plan view of a portion of the retractor system according to oneembodiment of the invention;
Figure 5 is a plan view of a portion of the retractor system according to anotherembodiment of the invention;
Figure 6A is a side elevational view of a retractor blade useful with the presentinvention;
Figure 6B is a plan view of the retractor blade of Figure 6A;
Figure 6C is a sectional view of the retractor blade of Figure 6B at lines 6C-6C;and
Figure 7 is a perspective view of a retractor blade according to the presentinvention, together with a surgical tool.
Referring to the drawings, Figure 1 shows asurgical retractor system 10 of thepresent invention. Theretractor system 10 is attached to an operating table (not shown) ina manner well known to those having ordinary skill in the art. Theretractor system 10includes aframe 12, which is preferably suspended above thepatient 14,common retractorblades 16, andretractor blades 18 having anaccess window 19. Thesystem 10 may alsoinclude a supportingarm 20 which may be connected to a support post (not shown) orsimilar elements to affix and support the retractor system in a desired position.
With further reference to Figures 1 to 2B and 4, theretractor system 10 of thepresent invention further includes one ormore fixation elements 22, such as thumb screws,that are effective to secureretractor blades 16, 18 to theframe 12 in a desired position sothat tissue can be retracted. In one embodiment, thesupport frame 12 is a four-sided,substantially rectangular object having a central opening 21. Eachside 12a, 12b, 12c, 12dofframe 12 includes one ormore mounting holes 24, which preferably are internallythreaded. Theholes 24 are adapted to threadably mate with a threadedshaft 26 offixationelements 22. Although shown as being substantially square or rectangular, it is understoodthatopposing sides 12a, 12b, 12c, 12d thatform frame 12 need not be parallel. Thus, theframe may be in the form of a circle or an oval, or it may be substantially O-shaped or D-shaped.
In one embodiment, themounting holes 24 formed in sides 12b and 12d arealigned so as to be parallel to the direction in which the sides 12b and 12d extend, enablingretractor blades 16 to be positioned at various locations along the length of sides 12b, 12d(in the x direction, as shown in Figure 2B). As shown best in Figure 2B,sides 12a and 12ceach includeflanges 28 that extend perpendicular tosides 12a, 12c, on either side ofsides12a, 12c. In thisembodiment mounting holes 24 are disposed inflanges 28 such that theholes extend in a direction substantially parallel to the holes formed in sides 12b, 12d. Thepresence of the flange structure enablesretractor blades 18 to be mounted securely on theframe 12 and to be positioned at various locations in the x direction (Figure 2B).Optionally,additional mounting holes 24a may be present onsides 12a, 12c, extending in a direction parallel to that in whichsides 12a, 12c are oriented. The presence ofmountingholes 24a allows theblades 16, 18 to be located in various positions in the y direction. Thecommon retractor blades 16 andretractor blades 18 each can be mounted onsides 12a, 12b,12c, or 12d.
The dimensions offrame 12 may vary as required by different surgicalapplications. The number and size of mountingholes 24 may vary as well. In oneembodiment, thesides 12a-12d have a length and a range of about 100 to 500 mm. In oneembodiment, theframe 12 may be square or rectangular, and the dimensions of centralopening 21 are in the range of about 80 by 150 mm to about 300 by 450 mm.Flanges 28preferably extend a distance L_f of about 20 to 60 mm. The number of mountingholes 24present in the sides and in theflanges 28 may vary as well. Generally, about 5-10holes 24and 24a are present in each of the sides while about 3-6holes 24 are formed in theflanges28. In one embodiment mounting holes may be placed entirely around the frame.
Figures 3A, 3B and 5 illustrate an alternative embodiment in which frame 12' is athree-sided member, which can be characterized as being substantially C-shaped. Asillustrated, frame 12' has along side 12a' and opposed shorter sides 12b' and 12c'. Thelong side 12a' preferably includes a number of mounting holes 24' that are oriented in adirection parallel to theside 12a'. The shorter sides 12b', 12c' each include flanges 28'that extend in a direction parallel toside 12a'. The flanges 28' preferably include a numberof holes 24' that are oriented in a direction parallel to the holes formed inside 12a'.
The dimensions of frame 12' can vary as well. The length ofside 12a' is in therange of about 150 to 500 mm while the length of sides 12b', 12c' is in the range of about100 to 300 mm. The length L_f of flanges 28' may be similar to that offlanges 28. Theflanges 28' can have the same as or a different number of holes as are present inflanges 28.
Thecommon retractor blades 16 may be of a type that includes a mountingsection41 and a tissue-retractingsection 43. The mounting section is substantially horizontallyoriented and the tissue-retracting section 32 is angularly oriented with respect °to themounting section. The tissue-retracting section 32 may be oriented at an angle of about 45to 135° with respect to the mounting section, and preferably at an angle of about 90°. Themounting section 30 further includes aslot 34 having screw nesting positions 36 as will bedescribed below with respect toretractor blade 18. As described above, the orientation ofthe holes on sides 12b and 12d (assuming one opts to mountblades 16 on sides 12b and 12d) allowsblades 16 to be mounted in various locations in the x direction. The positionofblades 16 in the y direction can be controlled by the positioning of the screw nestingpositions 36 ofslot 34 with respect tofastening element 22.
Thefixation elements 22 are used to secure the mountingportion 18 of ablade 16,18 to theframe 12. For purposes of illustration, thefixation elements 22 are shown asthumb screws, having ahead 27 and ashaft 26. Preferably, theshaft 26 has externalthreads 29, enabling the fixation element to mate withinternal threads 31 formed inmountingholes 24, 24a. Theshaft 26 of the fixation element should be appropriately sizedto fit within the mounting holes 24.
Theretractor blades 18 include features that allow tissue to be effectively retractedwhile increasing the surgeon's visual and physical access to the surgical site. Withreference to Figures 6A to 7, theblades 18 have a mountingportion 38 which, for referencepurposes, is substantially horizontally oriented, and an adjacent tissue-retractingportion 40.The mountingportion 38 includes anelongate slot 34. In one embodiment, theelongateslot 34 has a scalloped perimeter that defines multiple screw seating positions 36. That is,as is best shown in Figures 6B and 6C, theslot 34 includes multiple adjacent screw seatingpositions 36a, 36b, 36c etc.
The tissue-retractingportion 40 ofblade 18 includes a first section 42 that iscoplanar with the mountingportion 38 and asecond section 44 that is angularly orientedwith respect to the first section. Anopen access window 19 is formed in both the first andsecond sections 42, 44 of the tissue-retractingportion 40. Preferably, theaccess window19 is substantially centrally positioned within the first andsecond sections 42, 44. In oneembodiment at least a portion of either or both of the mounting or tissue-retractingportions38, 40 is malleable to enable a surgeon to optimize the shape of the blade for the bestperformance in tissue retraction. Selective malleability can be achieved by material choiceand/or by utilizing a thinner material in a region or regions ("bend zone") wheremalleability is desired.
As noted above, thesecond section 44 of the tissue-retractingportion 40 ofplate18 is angularly oriented with respect to the first section 42. The angle of orientation maybe in the range of about 45° to 135°, and preferably this angle is about 90°. In anembodiment in which the blade is malleable, the angular orientation may be selectivelyaltered by a surgeon.
Theaccess window 19 spans both the first andsecond sections 42, 44 of thetissue- retractingportion 40 and thus is three dimensional, as shown in Figure 7. Theaccess window 19 can be characterized as being substantially rectangular in shape, havingboth a generally horizontal (formed in the first section 42) and a generally vertical portion(formed in the second section 44).
The dimensions of theretractor blade 18 can vary upon the desired surgicalapplications. Referring to Figures 6A to 6C, the length of a horizontally extending portionL_H of theblade 18 is in the range of about 40 to 300 mm while the length of a verticallyextending section L_V is in the range of about 15 to 100 mm. The length of the tissueretracting portion is in the range of about 20 to 200 mm. The width of the blade at a widestsection (W₂) may be in the range of about 30 to 200 mm. As illustrated, one segment ofthe mountingportion 38 of theblade 18 may be slightly narrower than the width W₂. Thiswidth dimension (W₁) is in the range of about 10 to 100 mm and extends over a majority ofthe mountingportion 38 of the blade. The length of the narrower segment of the mountingportion, defined by L_H1 in Figure 6A, is in the range of about 20 to 250 mm.
As noted above, theslot 34 is elongate and generally has a length (L_s) in the rangeof about 20 to 200 mm. The width of the slot (W_s) is preferably in the range of about 3 to10 mm.
Theaccess window 19 preferably has a width (W_w) in the range of about 5 to90 mm. The length of the access window in the first section 42 of the tissue retractionportion 40 (L_w1) is in the range of about 15 to 195 mm while the length (L_w2) of the accesswindow in thesecond section 44 of thetissue retraction portion 40 is in the range of about40 to 300 mm. The length (L_v of thesecond section 44 of the tissue-retractingportion 40is about 20 to 250 mm.
Figure 7 schematically illustrates an advantage of theretractor blade 18 of thepresent invention. While theblade 18 is effective, in concert with other blades, to retracttissue, visual and physical access by the surgeon is enhanced as a result of theaccesswindow 19. That is, asurgical tool 46 is able to be passed through the access window to adesired location, or to further retract or otherwise manipulate tissue that is adjacent to theaccess window.
The components of the retractor system of the present invention can be made fromone or more biocompatible metals or metal alloys, or polymeric materials. An exemplary metal is titanium, while exemplary alloys include, but are not limited to, stainless steel(such as 316 LVM stainless steel), a titanium-vanadium-aluminum alloy (such as an alloyhaving about 90% by weight titanium, about 6% by weight aluminum, and about 4% byweight vanadium), a cobalt-chromium alloy, a cobalt-chromium-molybdenum alloy and acobalt-nickel-chromium-molybdenum alloy. Biocompatible polymeric materials are alsoincluded within the instant invention. Examples of such polymers include nylons,polyetherether ketones (PEEK), polyetheraryl ketones (PEAK), and polysulphones.

Claims

A surgical retractor system, comprising:
a support frame having a generally horizontally oriented support member havingformed therein a plurality of mounting holes;
at least one retractor blade, mateable at a selected position on the support frame,the at least one retractor blade having
a substantially elongate, horizontally oriented mounting portion havingformed therein a longitudinally extending slot, and
a tissue-retracting portion integral with and distal to the mountingportion, the tissue-retracting portion having a first section coplanar with themounting portion, a second section, angularly oriented with respect to the firstsection, and an open access window substantially centrally formed inboth the first and second sections of the tissue retracting portion; and
at least one fastening element effective to selectively mate one of the at least oneretractor blades to the support frame.
A system as claimed in claim 1, in which the support frame is a four sided,substantially rectangular member having an open interior portion.
A system as claimed in claim 2, in which each of the four sides of the frame areintegral with each other and the mounting holes are formed in each side and are adjacent toeach other.
A system as claimed in claim 3, in which at least one side of the frame has amounting flange integral therewith, and the mounting flange is oriented in a directionsubstantially perpendicular to the side of the frame with which it is integral.
A system as claimed in claim 4, in which the frame has first and second mountingflanges, each integral with opposite sides of the frame.
A system as claimed in claim 5, in which each mounting flange has mountingholes formed therein, and the mounting holes extend and are formed adjacent to each otherin a pattern that is parallel to the mounting flange.
A system as claimed in claim 6, in which each of the first and second mountingflanges has a length in the range of about 20 mm to 60 mm.
A system as claimed in claim 1, in which the support frame is substantially C-shaped,having a long side with mounting holes formed therein adjacent to each other andspaced along the long side in a pattern parallel to the long side, and first and second shortsides extending from opposite sides of the long side, in which each short side having atleast one mounting hole formed therein.
A system as claimed in claim 8, in which a plurality of mounting holes are formedin the short sides of the frame and extend in a pattern substantially perpendicular to themounting holes formed in the long side of the frame.
A system as claimed in claim 8, in which each of the first and second short sideshas a mounting flange integral therewith and oriented substantially parallel to the long side.
A system as claimed in claim 10, in which each mounting flange has mountingholes formed therein, and the mounting holes extend and are formed adjacent to each otherin a pattern that is parallel to the mounting flange.
A system as claimed in claim 1, in which the mounting holes include internalthreads.
A system as claimed in claim 1, in which at least part of the mounting portion hasa width in the range of about 30 to 200 mm.
A system as claimed in claim 1, in which the slot has a length in the range ofabout 20 to 200 mm and a width in the range of about 3 to 10 mm.
A system as claimed in claim 1, in which the first section of the tissue retractingportion has a width in the range of about 30 to 100 mm.
A system as claimed in claim 15, in which the combined length of the mountingportion and the first section of the tissue retracting portion is in the range of about 40 to300 mm.
A system as claimed in claim 1, in which the length of the second section of thetissue retracting portion is in the range of about 20 to 250 mm.
A system as claimed in claim 1, in which the open access window extendscontinuously from the first section to the second section of the tissue retracting portion.
A system as claimed in claim 18, in which length of the open access window inthe first section of the tissue retracting portion is in the range of about 15 to 195 mm.
A system as claimed in claim 18, in which the length of the open access windowin the second section of the tissue retracting portion is in the range of about 40 to 300 mm.
A system as claimed in claim 1, in which the second section of the tissueretracting portion extends at an angle of about 90° with respect to the first section of thetissue retracting portion.
A system as claimed in claim 1, in which the at least one mounting screw is athumbscrew.
A system as claimed in claim 1, in which the slot has a scalloped perimeterdefining multiple screw seating positions.
A system as claimed in claim 1, in which the fastening element is a mountingscrew having a head and a threaded shaft.
A system as claimed in claim 1, in which at least a portion of each of the at leastone retractor blades is malleable.
A surgical retractor blade, comprising:
a substantially flat, elongate first portion extending in a first orientation, the firstportion including an open access window formed in the blade and providing an openingtherein; and
a substantially flat, elongate second portion integral with the first portion andextending in a second orientation, the second portion having a first section with the openaccess window formed therein and providing an opening therein, and a second sectionintegral with and adjacent to the first section.
A blade as claimed in claim 26, in which the first portion includes one or morepositions effective to mate with a fastening element.
A blade as claimed in claim 27, in which the positions effective to mate with afastening element are present in a mounting slot formed in the first portion of the blade.
A blade as claimed in claim 26, in which the slot has a scalloped perimeterdefining multiple positions effective to mate with a fastening element.
A blade as claimed in claim 26, in which the second portion is adapted to engageand retract tissue.
A blade as claimed in claim 29, in which the first orientation is horizontal and thesecond orientation is vertical.
A blade as claimed in claim 29, in which the second portion is angularly orientedwith respect to the first portion, preferably with the angle between the first and secondportions in the range from about 45 ° to 135°.
A blade as claimed in claim 31, in which the second section of the second portionis solid.
A blade as claimed in claim 33, in which the slot is elongate.